Incidence of Frailty in Community-Dwelling United States Older Veterans.

OBJECTIVES: Determine the incidence rates of frailty among community-dwelling older veterans. DESIGN: Population-based retrospective cohort study. SETTING AND PARTICIPANTS: Veterans Health Administration Medical Center study included community-dwelling veterans 60 years and older with determinations of frailty from 2013 to 2014 and followed until September 2019. METHODS: A 31-item frailty index was generated at baseline and during each subsequent primary care encounters as a proportion of potential variables from electronic health record data. Period prevalence was calculated by dividing total number of cases of frailty during the baseline period. After adjusting for covariates, the association of frailty with mortality was determined using a multivariate Cox regression model. Using baseline and follow-up data, incidence rates of frailty per 1000 person/years based on event rates and mean duration of follow-up were calculated, including survivor and entire cohorts. RESULTS: Patients in this cohort were 16,761 veterans, mean age 72.18 (9.32) years, 74.00% Caucasian, 90.75% non-Hispanic, and 97.78% male. The period prevalence of frailty in this cohort was 20.84%. Over a median follow-up of 3.96 (interquartile range = 3.73) years, 25.86% of the baseline population died during follow up. Veterans with frailty had a higher all-cause mortality during follow up, adjusted hazard ratio = 3.12 (95% confidence interval 2.87-3.38), P value of < .0005. Among 10,513 veterans who survived a median follow-up of 4.81 (interquartile range = 3.12) years, 29.84% became frail. The incidence rate of frailty was 75.05 cases per 1000 person-years. Among the entire cohort of 13,268 nonfrail veterans, 29.93% became frail. The incidence rate of frailty was 84.03 cases per 1000 person-years. CONCLUSIONS AND IMPLICATIONS: This study shows high incidence of frailty in community dwelling older US veterans. Future studies should be done for identification, implementation of adequate interventions aimed at preventing frailty or reducing frailty-related complications in community dwelling older individuals.

The cross-sectional association of frailty with past and current exposure to strong anticholinergic drugs.

BACKGROUND: Anticholinergic drugs may contribute to frailty by impairing cognitive and physical functions. Strong anticholinergic drugs in particular may have adverse effects among older adults. OBJECTIVES: Determine the association between frailty and the use of strong anticholinergic drugs among older US Veterans. METHODS: This is a cross-sectional study of community-dwelling Veterans 65 years and older who had determinations of frailty status. Prescription data for patients using strong anticholinergic medications (never/past/current) was obtained via electronic health records. A 31-item VA Frailty Index (VA-FI) was generated at the time of the assessment. We dichotomized the groups into non-frail (FI = < 0.21) and frail (FI ≥ 0.21) patients. We used binomial logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Frailty was the dependent variable and use of strong anticholinergic drugs was the independent variable. Multivariate adjustment was conducted for age, gender, race, ethnicity, marital status, and BMI. RESULTS: Population sample consisted of 17,084 Veterans who were 71.05% Caucasian, 97.34% male, and with a mean age 75.60 (SD = 8.04) years. Among the population, 9940 (58.18%) patients had no previous use of strong anticholinergic drugs, whereas 5182 (30.33%) had past exposure and 1962 (11.49%) had current exposure. In binomial logistic regression, individuals with past (OR 3.27, 95% CI 3.03-3.54, p < 0.0005) or current (OR 4.78, 95% CI 4.30-5.31, p < 0.0005) exposure showed a higher association with frailty as compared to individuals who were never exposed. CONCLUSIONS: Past and current use of strong anticholinergic drugs were associated with frailty in older Veterans. These results suggest that screening for frailty in patients with past or current exposure to strong anticholinergic medications may be necessary for proper management.

Efectos de la pliometría en la fuerza explosiva de miembros inferiores en la lucha libre senior / Effects of plyometrics on the explosive strength of lower limbs in senior freestyle wrestling

RESUMEN Introducción: La fuerza explosiva es la capacidad física de generar una mayor fuerza muscular en un menor tiempo sin pérdida de eficacia, lo que es un componente determinante de la preparación deportiva y un indicador indirecto del rendimiento en lucha deportiva. Objetivo: Mejorar la fuerza explosiva en miembros inferiores a través de ejercicios pliométricos en luchadores libres, categoría senior. Métodos: Estudio cuasi-experimental de corte correlativo, para el cual se aplicó un programa pliométrico de tres fases, en miembros inferiores, conformado por una población de 15 luchadores (sexo masculino, sub-21 años), y fue evaluado el estímulo en la capacidad fuerza explosiva. Resultados: Se estableció mejoras significativas en la prueba de salto vertical (SV: p = 0,000), salto horizontal (SH: p = 0,000), carrera en 20 m (C20m: p = 0,000) y el test de salto 8 (S8: p = 0,001), y en todos los casos se favoreció al postest. Se determinó una correlación lineal positiva moderada entre SV y SH (0,50), una correlación negativa moderada entre SH y C20m (-0,58), una correlación negativa muy baja entre SV y C20m (-0,03), una correlación positiva moderada entre SV y S8 (0,61), una correlación positiva muy baja entre SH y S8 (0,16) y una correlación positiva moderada entre C20m y S8 (0,59). Conclusiones: Con la intervención pliométrica se demuestra una mejora significativa en la fuerza explosiva de miembros inferiores, lo que resulta en una alternativa eficaz para mejorar indirectamente el rendimiento deportivo. De las 6 correlaciones lineales realizadas, 4 fueron de índole moderada, esto evidencia que la potenciación pliométrica de un plano muscular específico puede mejorar consecutivamente otros planos musculares relacionados con la rapidez y la fuerza explosiva.

ABSTRACT Introduction: Explosive strength is the physical capacity to generate greater muscular strength in a shorter time without losing effectiveness. This is a crucial component of sports training and an indirect indicator of yield in wrestling. Objective: Improve the explosive strength of the lower limbs through plyometric exercises performed by senior freestyle wrestlers. Methods: A correlational quasi-experimental study was conducted based on a three-stage plyometric program for the lower limbs. The study population was 15 wrestlers (male sex, age under 21 years) who were evaluated for explosive strength capacity. Results: Significant improvement was established in the following tests: vertical jump (VJ: p = 0.000), horizontal jump (HJ: p = 0.000), 20-meter dash (D20m: p = 0.000) and jump 8 (J8: p = 0.001). In all cases the post-test obtained better results. Determination was made of a moderate positive linear correlation between VJ and HJ (0.50), a moderate negative correlation between HJ and C20m (-0.58), a very low negative correlation between VJ and C20m (-0.03), a moderate positive correlation between VJ and J8 (0.61), a very low positive correlation between HJ and J8 (0.16) and a moderate positive correlation between C20m and J8 (0.59). Conclusions: The plyometric intervention was found to significantly improve the explosive strength of lower limbs, thus becoming an effective alternative to indirectly enhance sport yield. Of the six linear correlations performed, four were moderate, which shows that plyometric strengthening of a specific muscular plane may consecutively improve other muscular planes related to speed and explosive strength.

Healthcare Utilization by Frail, Community-Dwelling Older Veterans: A 1-Year Follow-up Study.

OBJECTIVES: Frailty is a prevalent clinical syndrome associated with a high risk of adverse health outcomes, including disability, morbidity, and mortality, that has become a major challenge for the healthcare system. The aim of this prospective study was to determine the level of healthcare utilization in prefrail and frail community-dwelling older military veterans. METHODS: We studied a cohort of community-dwelling older veterans aged 65 years and older 1 year at the Miami Veterans Affairs Medical Center to determine their levels of healthcare utilization. We administered the 5-item FRAIL (Fatigue, Resistance, Ambulation, Illnesses, & Loss of Weight) scale, from which patients were categorized into three groups: robust, prefrail, and frail. Chart reviews were conducted to confirm weight loss and number of illnesses. One year later, information regarding hospital admissions, emergency department (ED) visits, and primary care visits was obtained. RESULTS: We evaluated 291 participants, mean age 74 ± 8 years, 112 (38.5%) of whom were African American, 179 (61.5%) were white, and 40 (13.7%) were Hispanic. Overall, 49 (16.8%) participants were frail, and 161 (55.4%) prefrail. After adjusting for age and Charlson Comorbidity Index, frail status was associated with ED admission (odds ratio [OR] 2.7, 95% confidence interval [CI] 1.2-6.1) and primary care visits (OR 3.4, 95% CI 1.5-7.3); however, it was not significantly associated with hospital admission (OR 2.2, 95% CI 0.9-5.2). CONCLUSIONS: In a sample of community-dwelling older veterans, frailty was found to be significantly associated with an increased frequency of ED visits and primary care visits, but not with hospital admissions. Identifying patients with frailty may allow for targeted interventions that improve healthcare outcomes and may reduce healthcare utilization.